Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN009620 | GA |
N | 1223P0221X | Pediatric Dentist | DN009620 | GA |
NPI | 1083728968 |
---|---|
Provider Name | Dr. John West Bryson |
First Address | Midland, GA 31820-3807 |
Second Address | Fort Benning, GA 31905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 08/07/2007 |